Physicians have long advised people recovering from deep vein thrombosis to wear compression hosiery to avoid the complications that often follow. But there has been little proof that the stockings work for the condition. Now a recent study in the Annals of Internal Medicine shows that they do. In August 2004, researchers reported that the use of compression hosiery reduced by about half the number of cases in which complications occurred.

This new data reinforces what some providers already know: Compression hosiery is in big demand. Indeed, deep vein thrombosis is just one of the conditions that can benefit from compression hosiery. More common reasons for wearing the hose include the treatment of venous insufficiency, edema, varicose veins, and lymphedema. Pregnant women wear them to reduce swelling, frequent travelers use them to promote circulation, even beauty seekers rely on them after cosmetic surgery.

A Cash Market
With a range of applications and demographics, compression hosiery is proving to be a lucrative cash market. Typically, Medicare does not cover hosiery and many private insurance companies are cutting back on benefits. Anecdotal evidence shows that for many providers approximately one third of compression hosiery sales are cash. So how can you get a leg up in the compression hosiery business?

Start with an Educated Staff
Experts agree that one of the biggest misconceptions about the selling and marketing of compression hosiery is that it is easy and requires little time. “The opposite is true,” says Cindy Ciardo, CO, BOC, of Wisconsin-based Knueppel HealthCare Services Inc. “To be successful, you need to have well-trained people who can measure, fit, and educate the client.”

At Knueppel, a provider specializing in rehabilitation and fitting services, all fitters are required to be BOC certified and the facility is accredited by ACHC. These professional fitters work with clients on a one-on-one basis, providing service and education. Doing the job right from the start is critical to success because word of mouth is the biggest way to get referrals and increase your business.

Successful providers place a high priority on the initial visit with a new customer. “I schedule appointments in advance and allot 45 minutes,” says Heidi Javorek, CPO, at Home Care Medical in New Berlin, Wis. “The fitting is just a small part of what we do; the remainder of the time is for patient education.”

A trained fitter will review the doctor’s prescription and make sure the compression level and type of hosiery are the best choice for the patient. Trained fitters are aware of conditions that require special attention such as diabetes or latex allergies. In these cases, only specific types of hosiery can be worn.

The next step is a thorough education process. Your fitters should be well prepared to show a patient how to put on and take off compression hosiery. They must also address issues such as when to wear the hose, how long to wear them, how to care for them, and when to replace. In addition, you can provide patients with written instructions, information, and educational resources. “It is important to inform and educate patients so that the hosiery works for their condition, but also so that you retain them as future customers,” says Javorek. While postsurgical patients may require compression hosiery for only 4 to 6 weeks, Javorek says that the majority of her patients require the hose for a lifetime. When you consider that regular compression hosiery typically lasts 6 months and custom-made hosiery just 4 months, that is a lot of reorders you can anticipate.

When working with customers, it is also critical to answer inquiries and address concerns. Javorek says some of the common concerns include tightness and comfort. “Some patients think that they will never be able to get them on at home or that the hose is cutting off their circulation,” said Javorek. The key is to employ fitters who can provide patients with workable strategies that enhance compliance.

Professional follow-up is equally important. Javorek schedules a follow-up meeting 1 month after the initial appointment. The goal is to remeasure the patient because often after wearing the hosiery, swelling reduces and a new compression level is required. At the same time, a second appointment gives the fitter another opportunity to resolve problems and strengthen the customer relationship.

Maximize Your Merchandise Mix
To be a player in the compression hosiery business, you need to offer a comprehensive merchandise mix. Your inventory should include both medical grade and over-the-counter compression hosiery. If you plan to specialize in compression therapy, you should also be prepared to offer custom-fabricated hosiery for patients with special needs. For example, bariatric patients and people suffering from lymphedema often require custom-made products.

Medical compression hosiery provides 18 mm of mercury compression (mm Hg) or greater, is prescribed by a physician, and is covered by some insurance plans. Over-the counter products are generally those below 18 mm Hg of compression and do not require a prescription unless they are being billed to an insurance company. While medical compression hosiery is prescribed for a variety of diagnoses, over-the-counter products are used primarily as a preventative measure for venous-related problems.

Naturally, you will want to carry a full range of styles and sizes of both medical and over-the-counter hosiery. This will ensure that in most cases you can complete the fitting process in one visit, making it convenient for customers and practical for you.

But to really stay competitive, you will need to stay on top of the trends. Today’s manufacturers are offering a wide variety of fashion-forward products for both men and women. “Manufacturers have done an amazing job in making compression hosiery cosmetically appealing,” says Ciardo. Today’s options include sheer, opaque, and patterned fabrics; trouser, athletic, and casual socks; fashion pantyhose and stockings; diabetic and sensitive-feet socks; and maternity pantyhose.

Plan to offer an array of style, color, and fabric selections. “Having a greater selection of product available is important because more educated consumers and fashion-conscious Baby Boomers are demanding choices,” says Ciardo.

Advertising and Promotions
Your marketing mix is as vital as your merchandise mix. Experts agree that eye-catching, in-store displays are a good way to boost sales of over-the-counter hosiery. Both Knueppel HealthCare Services and Home Care Medical recommend prominent on-site displays.

It makes sense to place your display in a high-traffic area. Ciardo recommends positioning the hosiery display in your store to cross-sell with complementary products. Javorek notes the importance of displaying various colors and styles as well as using mannequins and swatch samples. “Customers want to touch and feel the fabrics and see the stockings on a mannequin leg,” says Javorek.

While medical compression hosiery should be kept in a stockroom, over-the-counter products can be appealingly displayed along with product literature. Sales of your medical line will typically come from physician referrals, but an inviting display can be foster retail cash sales on over-the-counter hosiery.

Advertising, promotions, and direct mailings are also proven tools. Newspaper ads can keep your business visible with your local market or advertising in airline magazines can help you target a niche market, for example. Consider posting flyers at hospitals and other health care facilities. Attend local trade shows for increased community exposure. Host special events at your facility such as a “leg health day.” Or develop your own newsletter to promote new products, offer incentives, and remind customers about limited life expectancy of products.

As with any retail business, holding a semiannual sale can boost your bottom line. For all private pay customers, Javorek offers a 10% discount and waives the fitting fee which is typically $50 to $75.

Build Referral Business
Positioning yourself as an expert is key when it comes to winning the trust of health care professionals. Promote your qualifications—your training, experience, and certifications. “We market our services to physicians and therapists, especially lymphedema therapists,” says Ciardo. “We provide educational in-services to physicians, nurses, therapists, as well as support groups.” Make your business a valuable resource and referrals will follow.

And remember, you will be serving a diverse group that includes cardiologists, plastic surgeons, vascular surgeons, and family practitioners. Their knowledge of compression hosiery will vary. For example, many family practitioners have a vague notion of the options, so make sure your sales force is equipped with samples and fully trained to educate physicians.
At Home Care Medical, Javorek designed her own stocking-specific prescription pad, complete with diagnoses and compression levels for easy check-off by the physician. A tool like this is convenient and keeps your business name visible.

In the end, doctors want to work with providers who make their jobs easier by keeping patients satisfied and compliant. If your staff provides a genuine helping hand—expert fittings, patient education, follow up support—you will get a leg up in the fast-growing compression hosiery business.

Marianne Matthews is a contributing writer for Dealer/Provider.